Healthcare Provider Details

I. General information

NPI: 1770255382
Provider Name (Legal Business Name): ISSA SPEECH THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 GOLFSIDE DR STE 6
ANN ARBOR MI
48108-1410
US

IV. Provider business mailing address

2900 GOLFSIDE DR STE 6
ANN ARBOR MI
48108-1410
US

V. Phone/Fax

Practice location:
  • Phone: 734-224-9121
  • Fax:
Mailing address:
  • Phone: 734-224-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHLAM ISSA ISSA
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MA
Phone: 734-945-9628